Attitudes and Intentions regarding Abortion Provision among Medical School Students in South Africa

CONTEXT: Although South Africa liberalized its abortion law in 1996, significant barriers still impede service provision, including the lack of trained and willing providers. A better understanding is needed of medical students' attitudes, beliefs and intentions regarding abortion provision.

METHODS: Surveys about abortion attitudes, beliefs and practice intentions were conducted in 2005 and 2007 among 1,308 medical school students attending the University of Cape Town and Walter Sisulu University in South Africa. Bivariate and multivariate analyses identified associations between students'characteristics and their general and conditional support for abortion provision, as well as their intention to act according to personal attitudes and beliefs.

RESULTS: Seventy percent of medical students believed that women should have the right to decide whether to have an abortion, and large majorities thought that abortion should be legal in a variety of medical circumstances. Nearly one-quarter of students intended to perform abortions once they were qualified, and 72% said that conscientiously objecting clinicians should be required to refer women for such services. However, one-fifth of students believed that abortion should not be allowed for any reason. Advanced medical students were more likely than others to support abortion provision. In multivariate analyses, year in medical school, race or ethnicity, religious affiliation, relationship status and sexual experience were associated with attitudes, beliefs and intentions regarding provision.

CONCLUSIONS: Academic medical institutions must ensure that students understand their responsibilities with respect to abortion care--regardless of their personal views--and must provide appropriate abortion training to those who are willing to offer these services in the future. International Perspectives on Sexual and Reproductive Health, 2012, 38(3): 154-163, doi: 10.1363/3815412

Voluntary induced termination of pregnancy is a common medical procedure worldwide. An estimated 42 million abortions are performed annually; nearly 20 million are considered medically unsafe. (1-4) Estimates suggest that 97% of unsafe abortions occur in the developing world, and that unsafe abortion is the leading cause of maternal deaths in Africa, which has the world's highest case-fatality rates. (2), (3), (5), (6)

After a 1994 study found that an estimated 45,000 South African women per year were admitted to public hospitals as a result of incomplete or unsafe abortion, (7), (8) the country legalized abortion in 1996. Prior to this change in the law, abortion had been legal in very limited circumstances under the Sterilization Act of 1975, requiring the approval of three physicians. The 1996 law specifies that a woman can obtain an abortion on request within the first 12 weeks of pregnancy. (9) Between 13 and 20 weeks' gestation, a woman can obtain an abortion if at least one of four criteria is satisfied: continuing the pregnancy would pose a risk to the woman's mental or physical health; there is significant risk that the unborn child would have a mental or physical handicap; the pregnancy was the result of rape or incest; or having the child would be detrimental to the woman's socioeconomic condition. (9) Beyond 20 weeks, abortion is sanctioned only when the woman's life is endangered. In addition, although medical providers can conscientiously object to performing abortions, providers who are unwilling or unable to offer abortion services are legally obligated to inform women of their rights and to refer them to other providers.

As part of a series of progressive human rights initiatives undertaken by the postapartheid government, the 1996 law extended abortion provision to all provinces in South Africa, and free abortion services were provided in public clinics and hospitals. (9) Although the legalization of abortion often leads to a considerable decrease in maternal morbidity and mortality through the resulting decline in unsafe abortions, (10) it does not necessarily ensure effective implementation of and access to medically safe abortion services. …

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